Sunday, 21 August 2011

The Start of the Change

So it's only taken 32 years but now it's time for me to take the control.

My always dreaded HbA1c managed to creep over 10 in April this year so the nurse at my doctor decided it was time I got to the consultant (endo) at the hospital. Being a little bit of a swat this scared me a little so I cracked on for the next few weeks trying to get everything more under control.

For the first time, I stepped into the Diabetes Online Community (DOC) and after browsing a few forums where tests results were displayed as badges of honour, I eventually came across a few that had real people with similar issues and concerns to me. My first plug here for Shoot Up or Put Up who gently nurtured me and gave me some confidence to go to my appointment with the facts and questions I needed to try and sort myself out. To say I was fired up and ready with all my guns would be a good analogy.

After getting over the initial teeth-sucking, the registrar and I agreed on a plan and I was fortunate to reunite with my Diabetes Specialist Nurse (DSN), Zoe, who I'd last seen in the last millennium. Sitting with her we sorted out a plan of attack. In conjunction with the dietitian we agreed that my high A1c was probably due to too many hypos rather than flying high all the time. This was a hugely new concept for me. The plan of attack was to lower my once-daily, nighttime basal and then match the bolus' to the carbohydrates in my food. This immediately sent me back thirty years with memories of weighing mashed potatoes and counting 'lines' or 'exchanges'. Some things stick and my first question was "Is a digestive biscuit still 1 line?" - and the answer is apparantly yes! After so many years of maintaining a casual relationship between food and dosage this seemed very strict but matched my mathematical brain which suggested the logic made perfect sense. I did ask about restarting a fitness campaign at the same time but was asked gently to hold off on that until my carb ratios were sorted.

Following this I've returned a few times and together we're getting there. My improvements have been helped greatly by recent technical improvements in my kit cupboard. First up came the Carbs & Cals iPhone app that's excellently useful in helping to judge the carbs in my food - I got the printed version first but the app has all the same content in a much quicker to read format. Next is the Novopen Demi that allows me to inject half units which is much easier when doing the maths for the carb ratios. Finally, and the newest arrival, is my Aviva Accu-chek Expert. It is fantastic and is part of the reason for the increased dilemma as to whether to switch to the pump or stay on MDIs. Mike has done a much better and longer review than I could possibly have done so I'll kindly link to him here. Thanks Mike.

A1c taken whilst at the hosptial for the first visit was 7.9 which shows what I could achieve without any professional input but obviously still a long way from the 6s I crave.

So that's where I am. On the road to better control but still not sure which path to take next. The next decision is the big one. Do I stick to MDIs or leap into the world of pumps?

Next up in the blog will be where I try and break down the advantages and disadvantages of Pump over MDI. Obviously switching to the pump would be a huge change for both me and my family so I need everyone, and especially my better half, to help me make the right choice.

As a post-script I'd like to send my love to those across in the US of A who aren't as fortunate as the majority over here in the Great of Britain. Whenever I need new insulin or test strips I just go online to my doctors website (just done as writing this reminded me I need more test strips), fill out a repeat prescription form and collect from the pharmacy two days later, for free - and that's the big bit. The NHS often gets a lot of stick but for me 'it does what it says on the tin' and I am truly grateful to be living in an age where it is available to keep me alive and in a country where I'm not at the whims of an insurance company whose business model is to try and restrict how much I can get.

Disclaimer - please read!

I am not a medical professional in any way. Nothing on this site should be construed as medical advice. Your diabetes will vary. Contact your health care provider for specific questions and advice. Without sounding like a pharmaceutical company – do not change medication, dosage or philosophy without speaking to your DSN, doctor, consultant or witchdoctor.